Medical Home Workflows

“Jaded Julie, in a symphony orchestra, how does one make sure that all of the bass fiddles play the same notes?”

“I don’t know much about orchestras, Curmudge, but I suspect that each bass player reads from an identical musical score.”

“Closer to home, Julie, if a sample is sent to the hospital’s lab for a multi-step analysis, should the result depend on who the analyst was?”

“Absolutely not! The lab has a standard process and procedure for every step in the analysis that each analyst must follow. Even a non-clinical old geezer like you should know that.”

“And finally, in a medical home with several patient service representatives, should a patient’s phone call to renew a prescription be handled differently depending on the PSR that she speaks with?”

“Of course not. I get it, Curmudge. In the medical home we have workflows just like an orchestra has scores and the lab has standard methods. It’s like you taught me, ‘You can’t improve a process until you can control it; you can’t control it until you understand it; and you can’t prove you understand it until you document it.’ The workflows get everyone on the same page. You can’t have people running around willy-nilly ‘doing their own thing.’”

“You are mighty quick on the uptake, Julie. Can you think of ways in which Lean is used in developing workflows?”

“You know I can. Where do you think I’ve been for the past three years? To begin with, you assemble a team from gemba who know best the processes and procedures in present use. They use sticky notes that are color-coded to differentiate patient service reps, health care associates, and providers. Then they make a process diagram on the conference room wall for each of the clinic’s main processes. Sometimes ‘just do it’ improvements are introduced as the workflow is being constructed.”

“That’s the idea, Julie. What happens next?”

“Then the workflow is copied from the wall with Visio software for printing, discussion, and further improvements. Later the team looks into the individual sticky-note boxes to identify procedures that need to be documented. It looks to me, Curmudge, as if workflows are standard work for clinic-wide processes and individual procedures.”

“The drivers for this effort are the forthcoming implementation of the electronic health record (EHR) and ultimate recognition by the National Committee for Quality Assurance (NCQA). As we said last week, one must not try to overlay a good technology on a bad process. Workflows represent the medical homes’ development of effective paper-based process and procedure descriptions for incorporation into the EHR.”

“It’s pretty obvious, Curmudge, that one must know where she is ‘at’ before finding her way to someplace better. By the way, do you realize that the next generation might not even know what a paper-based process description is?”

“That’s likely, Julie, but if there still are bass fiddles, I’ll bet that bass players will still be reading Beethoven from paper scores.”

Affinity’s Kaizen Curmudgeon